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Penile rehabilitationView Articles

Volume 8, Number 4Review Articles

Penile Rehabilitation After Radical Prostatectomy: Important Therapy or Wishful Thinking?

Management Update

Jesse N MillsRandall B MeachamJoseph E Dall'EraHari K Koul

On the basis of data accumulated thus far, it is reasonable to discuss the implementation of a “penile rehabilitation” program with patients undergoing radical prostatectomy. Central to discussions of penile rehabilitation after radical prostatectomy is evidence demonstrating significant fibrotic changes in the corpus cavernosum that occur postoperatively. Several studies have been published evaluating the efficacy of various pro-erectogenic agents. The limited data regarding intracavernous injections and vacuum constriction devices suggest that an increased percentage of treated patients experienced a return of natural erections compared with patients who received no treatment. Longer, prospective, randomized, placebo-controlled studies will be needed to confirm the utility of these treatments. Data from contemporary studies evaluating the chronic use of oral phosphodiesterase type 5 inhibitors suggest a beneficial effect on endothelial cell function among men suffering from erectile dysfunction due to a variety of causes. Limited data suggest that this effect might be seen among post-prostatectomy patients, implying a possible role for these agents in enhancing the return of sexual function in such individuals. [Rev Urol. 2006;8(4):209-215]

Radical prostatectomyErectile dysfunctionPenile rehabilitationPDE-5 inhibitorsHypoxiaIntracorporeal injectionVacuum constriction device

Pentosan polysulfate sodiumView Articles

Volume 12, Number 3Review Articles

Forensic Dissection of a Clinical Trial: Lessons Learned in Understanding and Managing Interstitial Cystitis

Management Update

J Curtis Nickel

A pharmaceutical company—sponsored post-registration clinical trial designed to determine the most effective dose of pentosan polysulfate for the treatment of interstitial cystitis (IC) reported negative results. However, because of a priori trial design features, important posthoc analyses were able to answer many of the important clinical issues on the epidemiology, diagnosis, and treatment of IC that to date had remained unanswered. Seven published follow-up reports based on data and outcomes from the original study evaluated the clinical significance of a positive Potassium Sensitivity Test, confirmed the O’Leary-Sant Interstitial Cystitis Symptom Index as a valid and sensitive outcome measure, and determined that doses of pentosan polysulfate higher than the standard US Food and Drug Administration—approved dose of 300 mg/d did not increase efficacy although increased duration of therapy increases the chance of symptom amelioration. Further analyses determined that sexual dysfunction is an important parameter to assess in IC and that successful therapy can improve sexual functioning. Finally, the data showed that symptom severity, quality of life (QoL), and sleep function are interrelated. Consequently, symptom improvement with therapy correlates with improvement in both sleep function and QoL. This post hoc forensic dissection of a clinical trial initially undertaken for simple regulatory reasons has significantly improved our understanding and management of the enigmatic condition we call IC. [Rev Urol. 2010;12(2/3):e78-e85 doi: 10.3909/riu0445]

Interstitial cystitisPentosan polysulfate sodiumPotassium sensitivity test

Percutaneous nephrostolithotomyView Articles

Volume 16, Number 1Review Articles

Calyceal Diverticula: A Comprehensive Review

Disease State Review

Zeph OkekeNikhil WaingankarSamih HayekArthur D Smith

Calyceal diverticula are rare outpouchings of the upper collecting system that likely have a congenital origin. Stones can be found in up to 50% of calyceal diverticula, although, over the combined reported series, 96% of patients presented with stones. Diagnosis is best made by intravenous urography or computed tomography urogram. Shock wave lithotripsy (SWL) is an option for first-line therapy in patients with stone-bearing diverticula that have radiologically patent necks in mid- to upper-pole diverticula and small stone burdens. Stone-free rates are the lowest with SWL, although patients report being asymptomatic following therapy in up to 75% of cases with extended follow-up. Ureteroscopy (URS) is best suited for management of anteriorly located mid- to upper-pole diverticular stones. Drawbacks to URS include difficulty in identifying the ostium and low rate of obliteration. Percutaneous management is best used in posteriorly located mid- to lower-pole stones, and offers the ability to directly ablate the diverticulum. Percutaneous nephrolithotomy remains effective in the management of upper-pole diverticula, but carries the risk of pulmonary complications unless subcostal access strategies such as triangulation or renal displacement are used. Laparoscopic surgery provides definitive management, but should be reserved for cases with large stones in anteriorly located diverticula with thin overlying parenchyma, and cases that are refractory to other treatment. This article reviews the current theories on the pathogenesis of calyceal diverticula. The current classification is examined in addition to the current diagnostic methods. Here we summarize an extensive review of the literature on the outcomes of the different treatment approaches. [ Rev Urol. 2014;16(1):29-43 doi: 10.3909/riu0581] © 2014 MedReviews®, LLC

UreterorenoscopyCalyceal diverticulaPercutaneous nephrostolithotomyLaparoscopic surgeryShock wave lithotripsy

Percutaneous nephrostomyView Articles

Volume 20, Number 1Review Articles

Factors Associated With Postoperative Infection After Percutaneous Nephrolithotomy

Risk Factor Analysis

Win Shun LaiDean Assimos

Numerous studies have investigated risk factors for the development of postoperative infection in percutaneous nephrolithotomy (PCNL) patients. Herein, we describe our meta-analysis of the risk factors for the prediction of post-PCNL infectious complications. We searched electronic databases using a combination of the terms percutaneous nephrolithotomy, risk factors, infection, and sepsis. The primary outcome was post-PCNL infection as defined by fever greater than 38°C or sepsis as defined by the Sepsis Consensus Definition Committee. Risk factors for infection in each study were identified and included for analysis if present in at least two studies. We used quantitative effect sizes in odds ratio to assess each endpoint. After application of criteria, 24 studies were found, of which 12 were prospective and 12 were retrospective. Of the prospective studies, preoperative urine culture, renal pelvis culture, stone culture, number of access points, hydronephrosis, perioperative blood transfusion, and struvite stone composition were found to be significantly associated with postoperative infection. Of the 12 retrospective studies, preoperative urine culture, stone cultures, number of access points, blood transfusion, stone size, and staghorn formation were associated with infection. Preoperative urine culture, stone culture, number of access points, and need for blood transfusion were consistently found to be significant factors. This indicates that the presence of bacteria in the urine/stone preoperatively as well as the amount of trauma the kidney sustains during the procedure are major predictors of postoperative infection. [Rev Urol. 2018;20(1):7–11 doi: 10.3909/riu0778] © 2018 MedReviews®, LLC

Urinary tract infectionNephrolithiasisLithotripsyPercutaneous nephrostomy

Phenotypic biomarkersView Articles

Volume 22, Number 4Review Articles

Application of Artificial Intelligence/Machine Vision & Learning for the Development of a Live Single-cell Phenotypic Biomarker Test to Predict Prostate Cancer Tumor Aggressiveness

Original Research

David M. AlbalaGrannum R SantJonathan S VarsanikMichael S ManakMatthew J WhitfieldBrad J HoganWendell R SuCJ JiangAshok C Chander

To assess the usefulness and applications of machine vision (MV) and machine learning (ML) techniques that have been used to develop a single cell–based phenotypic (live and fixed biomarkers) platform that correlates with tumor biological aggressiveness and risk stratification, 100 fresh prostate samples were acquired, and areas of prostate cancer were determined by post-surgery pathology reports logged by an independent pathologist. The prostate samples were dissociated into single-cell suspensions in the presence of an extracellular matrix formulation. These samples were analyzed via live-cell microscopy. Dynamic and fixed phenotypic biomarkers per cell were quantified using objective MV software and ML algorithms. The predictive nature of the ML algorithms was developed in two stages. First, random forest (RF) algorithms were developed using 70% of the samples. The developed algorithms were then tested for their predictive performance using the blinded test dataset that contained 30% of the samples in the second stage. Based on the ROC (receiver operating characteristic) curve analysis, thresholds were set to maximize both sensitivity and specificity. We determined the sensitivity and specificity of the assay by comparing the algorithm-generated predictions with adverse pathologic features in the radical prostatectomy (RP) specimens. Using MV and ML algorithms, the biomarkers predictive of adverse pathology at RP were ranked and a prostate cancer patient risk stratification test was developed that distinguishes patients based on surgical adverse pathology features. The ability to identify and track large numbers of individual cells over the length of the microscopy experimental monitoring cycles, in an automated way, created a large biomarker dataset of primary biomarkers. This biomarker dataset was then interrogated with ML algorithms used to correlate with post-surgical adverse pathology findings. Algorithms were generated that predicted adverse pathology with >0.85 sensitivity and specificity and an AUC (area under the curve) of >0.85. Phenotypic biomarkers provide cellular and molecular details that are informative for predicting post-surgical adverse pathologies when considering tumor biopsy samples. Artificial intelligence ML-based approaches for cancer risk stratification are emerging as important and powerful tools to compliment current measures of risk stratification. These techniques have capabilities to address tumor heterogeneity and the molecular complexity of prostate cancer. Specifically, the phenotypic test is a novel example of leveraging biomarkers and advances in MV and ML for developing a powerful prognostic and risk-stratification tool for prostate cancer patients. [Rev Urol. 2020;22(4):159–167] © 2021 MedReviews®, LLC

Prostate cancerArtificial intelligencePhenotypic biomarkersMachine visionMachine learning